The feasibility of implementing antibiotic restrictions for fluoroquinolones and cephalosporins: a mixed-methods study across 15 Veterans Health Administration hospitals

Author:

Livorsi Daniel J12,Suda Katie J34,Cunningham Goedken Cassie1,Hockett Sherlock Stacey12,Balkenende Erin12,Chasco Emily E12,Scherer Aaron M12,Goto Michihiko12,Perencevich Eli N12,Goetz Matthew Bidwell56,Reisinger Heather Schacht12,

Affiliation:

1. Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA

2. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

3. Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Health Care System, Pittsburgh, PA, USA

4. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

5. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

6. David Geffen School of Medicine at the University of California in Los Angeles, CA, USA

Abstract

Abstract Introduction The optimal method for implementing hospital-level restrictions for antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators to implementing restrictions for fluoroquinolones and third/fourth-generation cephalosporins. Methods This mixed-methods study across a purposeful sample of 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys and semi-structured interviews (September 2018 to May 2019). Surveys on stewardship strategies were administered at each hospital and summarized with descriptive statistics. Interviews were performed with 30 antibiotic stewardship programme (ASP) champions across all 15 sites and 19 additional stakeholders at a subset of 5 sites; transcripts were analysed using thematic content analysis. Results The most restricted agent was moxifloxacin, which was restricted at 12 (80%) sites. None of the 15 hospitals restricted ceftriaxone. Interviews identified differing opinions on the feasibility of restricting third/fourth-generation cephalosporins and fluoroquinolones. Some participants felt that restrictions could be implemented in a way that was not burdensome to clinicians and did not interfere with timely antibiotic administration. Others expressed concerns about restricting these agents, particularly through prior approval, given their frequent use, the difficulty of enforcing restrictions and potential unintended consequences of steering clinicians towards non-restricted antibiotics. A variety of stewardship strategies were perceived to be effective at reducing the use of these agents. Conclusions Across 15 hospitals, there were differing opinions on the feasibility of implementing antibiotic restrictions for third/fourth-generation cephalosporins and fluoroquinolones. While the perceived barrier to implementing restrictions was frequently high, many hospitals were effectively using restrictions and reported few barriers to their use.

Funder

VA Health Services Research and Development

Centers for Disease Control and Prevention

Career Development Award

Collaborative Research to Enhance and Advance Transformation and Excellence programme

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

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